Happy Men’s Health Month, Guys. What’s that all about, you ask? First established as National Men’s Health Week by Congress in 1994, largely due to the efforts of Senator Bob Dole, and signed into law by President Clinton (who says Reds and Blues can’t collaborate to get anything done?), it began as a week-long focus on gender disparities in health.

Did you even know such a thing existed?

It sure does, and the original Senate Joint Resolution pointed out a simple depressing fact: Despite numerous advances in med tech, the ladies outlive us dudes by seven years on average. The Resolution went on to provide a grocery list of the ways guys die, including from prostate cancer, testicular cancer, lung disease, colon cancer, and more -- followed up by the fact that many of these diseases would have had better outcomes if the dudes would’ve just gone to their frickin' doctors earlier.

I might have paraphrased that a bit. Senate Resolutions tend to be a bit stuffy for my taste.

But, “Whereas,” the text of the Resolution read, “men who are educated about the value that preventive health can play in prolonging their lifespan and their role as a productive family member will be more likely to participate in health screenings. Now, therefore, be it Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, that June 12 through 19, 1994, is designated as National Men’s Health Week, and the President is authorized and requested to issue a proclamation calling upon the people of the United States to observe this week with appropriate programs and activities.”

Of course, depending on how you want to look at it, the month may be pointless for us men living with T1D. That is, the charter of what is now Men’s Health Month is to increase awareness of preventable health problems and increase men’s interface with the healthcare community. But we already have non-preventable type 1 diabetes, and God knows we already interface plenty with the healthcare community. Still, we here at the 'Mine decided to take this opportunity to look at a few ways that diabetes affects guys, uniquely, as our own way of recognizing Men’s Health Month.

Let’s start by asking: What makes a man a man?

Of course, genetically, we’ve got that whole Y chromosome thing going on. Compared to women of our own race and ethnicity, we’re generally larger, and by this I mean taller, with heavier frames and a beefier muscle structure. Scientists like to call this sexual dimorphism. We guys tend to be hairier. What else? Oh, right. That whole wang thing. You know, we are equipped with a so-called "dong, Johnson, schlong" or—for the politically correct—a penis. 

How does diabetes affect each of these fundamental elements of manhood?

Protecting the Y

In a study published in the Journal of Fertilization in 2015, researchers in India took a look at “diabetic male infertility.” Now we all know that poorly controlled diabetes can lead to reduced fertility thanks to the perfect storm of erectile dysfunction, reduced sex drive, and lower ejaculate volume from damaged ejaculation nerves and diabetes-lowered testosterone levels. But here’s the newsflash: There’s stuff happening on the genetic level, too, and this team of scientists wanted to know more about the nuts (pardon the pun) and bolts of that.

So what did they find out? They found that infertile men with either type 1 or type 2 diabetes were literally missing parts of their Y chromosomes! Where the heck did the parts go? Somehow, the diabetes caused “microdeletions” of parts of the Y, and those missing parts in turn triggered “partial or complete spermatogenetic arrest,” or sperm death. Well, more correctly, lack of sperm formation. 

In blunt terms, the effing diabetes emasculated them.

It did this in two ways: First, the biological definition of manhood is a Y chromosome, and the diabetes just hit the erase key on part of it; and second, for many, a key component of manhood is being able to spread your genes, which is tricky to do with arrested sperm.

This was a major concern for the authors of the study too. They noted that given the growth in diabetes and, apparently, growth in global male infertility as well, “the future of male fertility may be impaired by diabetes mellitus.” 

Oh, great. Not only could diabetes be the genetic death of our gender thanks to Y chromosome deletions, it might even doom the entire human race… or at least stunt its growth.  

Stunted Growth? 

Speaking of stunted growth, I’m sure when you were 12 years old your mother told you not to drink coffee because it might stunt your growth. (This, by the way, is sorta true: Caffeine in high doses can increase the body’s elimination of calcium, but we’re not seeing an epidemic of dwarfism with the increase in Starbucks stores…) But what about diabetes? Can diabetes stunt your growth?

Uh… Yeah. Actually, it can. Interestingly, while there’s some evidence that type 1 kiddos are taller than their peers before diagnosis, they then suffer a “significant reduction in the pubertal growth spurt.”

In other words, diabetes can stunt your growth both in speed and final height. Now, there’s some evidence that the quality of diabetes control has a part to play, as it does with all types of diabetes complications, with poorer control linked to reduced “growth velocity.” Additionally, there’s some anecdotal evidence seen for type 1 males also being generally lighter of frame than their "sugar-normal" counter parts, with a thinner, leaner build. More Alan Alda than cave man.

Oh, and speaking of cavemen…

Diabetes Can Be Hairy… Or Not 

What about that fundamental badge of manhood since the cavemen: Our beards and our body hair? Does diabetes affect our fur?

Image: American Academy of Dermatology

Yes, damn it. It does. Diabetes messes with the usual hair growth cycle, resulting in a greater loss of hair body-wide during the resting cycle, and a reduced and slowed re-growth during the replacement cycle. Research also shows that hair shaft diameter is “significantly reduced" in people with diabetes, and on top of that, meet alopecia areata, an immune system attack on hair follicles more common in those of us who have diabetes.

It’s a wonder we don’t all look like hairless, grey aliens.

For guys who developed T1 before puberty, reduced testosterone levels often lead to reduced caveman body hair and thinner, fairer “peach fuzz” beards in the first place, all of which last into adulthood. 

Oh, and this German study looked at pubic hair, literally, to evaluate “pubertal onset” in type 1 kiddos. Their findings? Boys (and girls) with diabetes bloom late, but at least reach sexual maturity on time. There was no data about the quality of the pubic hair shaft diameter this time, but speaking of the pubic area…

The Heart of Manhood

All political correctness aside, I think we can all acknowledge the fact that a great many men (and a good number of women, as well) measure manhood below the belt, and it’s no newsflash that diabetes affects that area.

Much has been written on the links between diabetes, blood sugar control, and erectile dysfunction (ED), so I’ll keep it brief. Men with diabetes suffer more ED, and get it at an earlier age. Higher blood sugar most definitely makes it worse -- and the higher the blood sugar, the lower your erection -- but there appears to also be an inherent risk just from having diabetes, regardless of blood glucose control.

Flip the Coin

Well, crap. Everything we are as men—our Y chromosome, our manly size, our caveman beards, and our massive codpieces—are all brought down by our diabetes. So now what?

Have heart and look to the other part of the month: Health.

Even if we might end up less “manly” than the men of the past—with our damaged chromosome, slightly reduced size, thinner beards and balding heads, and at-risk bedroom capabilities—we can have the ultimate revenge against diabetes and live up to the original charter of Men’s Health Month. 

That is: do everything in our power to live healthfully.

So Gentlemen PWDs (people with diabetes) reading this: Go see your doctor regularly. Mind your glucose managment, and take care of all the other aspects of your diabetes -- and whatever else may ail you. Get your recommended health screenings. Encourage the other men in your life to do the same, and maybe we can have the last laugh by outliving the ladies. 

Despite our manly diabetes.